Sr. Care Coordinator, DentaQuest

Sun Life U.S. is one of the largest providers of employee and government benefits, helping approximately 50 million Americans access the care and coverage they need. Through employers, industry partners and government programs, Sun Life U.S. offers a portfolio of benefits and services, including dental, vision, disability, absence management, life, supplemental health, medical stop-loss insurance, and healthcare navigation. We have more than 6,400 employees and associates in our partner dental practices and operate nationwide.

Visit our website to discover how Sun Life is making life brighter for our customers, partners and communities.  

DentaQuest manages dental and vision benefits for more than 33 million Americans. Our outcomes-based, cost-effective solutions are designed for Medicaid and CHIP, Medicare Advantage, small and large businesses, and individuals. With a focus on prevention and value, we aim to make quality care accessible to improve the oral health of all.

Job Description:

Location: Looking for someone who lives in Oregon

The opportunity:  The Care Coordinator is responsible for supporting the organization's services with members and providers. This position serves as an advocate and coordinator for members that have special health care needs, are in a designated population, or have behavioral concerns. The Care Coordinator is designated as the company’s Intensive Need Care Coordinator for purposes of CCO/OHA contractual requirements.

How you will contribute: 

• Intensive Needs Care Coordination as required by contract with Coordinated Care Organizations (CCOs) and the Oregon Health Authority (OHA) providing targeting services to members with special physical, mental, environmental or age-related needs
• Research and resolve all Case Management requests received from the Provider Network in regard to behavior, fraudulent, or special healthcare needs that cannot be met in the office setting
• Out of Network service arrangements with out of network providers based on organization’s policies
• In Area, Out of Network service arrangements with local out of network providers in order to provide local specialized treatment where needed based on organization’s policies
• Coordinate with CCO’s, Resource Parents and providers to ensure all DHS Foster children are seen in a timely manner.
• Processing of items needing additional coordination, such as:
• o Member request for assistance through a Health Risk Screening
• o Processing of Second Opinion requests from members
• o Processing of Tribal Health Referrals
• o Processing Permanent Referral Requests from PCDs
• Assist with care coordination of members with special health care needs as designated by CCO, OHA, members, members’ caregiver or representative. This includes, but is not limited to:
• o Engaging foster parents in assessments for members in foster care as reported by the CCO
• o Initiating care for members that are indicated as residing in care facilities or those with social determinants of health (SDoH) as indicated by the CCO
• Ensure all documentation is entered accurately and timely into all case management systems for continuity of care purposes
• Assist in improving the region’s health by considering each community member’s unique health, cultural and social needs
• Other duties as needed or required.

What you will bring with you: 

• High school diploma or equivalent
• 2+ years of experience working with Medicaid populations by phone or in person; knowledge of Oregon Medicaid highly preferred
• 6+months of experience working in an entry level Care Coordinator or Case Manager position (or equivalent)
• Experience with trauma informed care preferred
• Computer proficiency in a variety of Windows applications
• Attends additional training as requested/deemed necessary

Preferred:

• Certification as a Community Health Worker or other Traditional Health Worker designation
• Associates or Bachelor’s Degree in Social Work
• Experience in a dental/medical insurance setting

Physical Demands:

• Incumbent must be able to communicate effectively.
• Requires overall light physical effort (up to 25lbs.)
• Manual dexterity and sitting is required in carrying out position own position responsibilities (i.e. use of personal compute).
• Ability to travel or move about within and outside serviced facilities r